How to Stop Avoiding People Due to Social Anxiety: The Melatonin Connection You Haven’t Heard About

Story-at-a-Glance

• Social anxiety affects approximately 15 million American adults and causes significant avoidance of social situations, impacting work, relationships, and quality of life
• Melatonin demonstrates anxiolytic properties through multiple mechanisms including modulation of the HPA axis, enhancement of GABAergic signaling, and reduction of sympathetic nervous system overactivity
• Clinical trials show melatonin reduces preoperative anxiety with efficacy comparable to benzodiazepines but without cognitive impairment or dependency risks
• Research suggests melatonin facilitates fear extinction—the process central to overcoming social avoidance patterns—by supporting the neuroplasticity required for exposure therapy success
• Behavioral strategies including graded exposure therapy, cognitive restructuring, and social mishap exposures form the foundation of effective social anxiety treatment, potentially enhanced by melatonin’s neurobiological effects
• Professional evaluation remains essential when social anxiety significantly impairs functioning, as comprehensive treatment typically requires both psychological and biological interventions

When research published in 2024 revealed that 43% of American adults felt more anxious than the previous year—up from 37% in 2023—it confirmed what many already suspected: we’re in the midst of an unprecedented anxiety crisis. But here’s what caught my attention as I reviewed the research: buried within the neurobiological mechanisms of anxiety lies a hormone most people associate only with sleep, yet it may hold remarkable promise for those struggling to stop avoiding people due to social anxiety.

Social anxiety disorder isn’t simply shyness or occasional nervousness. It’s a persistent, often debilitating fear of social situations where judgment might occur. For the approximately 15 million Americans living with this condition, every social interaction becomes a calculated risk, every gathering a potential catastrophe. The avoidance that develops—skipping the office party, declining the dinner invitation, avoiding eye contact on public transportation—provides temporary relief but reinforces the very fears that imprison us.

The Neurobiology Behind Social Withdrawal

Understanding how to stop avoiding people due to social anxiety requires first understanding what’s happening in your brain when that familiar dread surfaces. The neurobiology is more complex than a simple “chemical imbalance,” involving an intricate dance between multiple brain systems.

The hypothalamic-pituitary-adrenal (HPA) axis serves as your body’s stress response system. In social anxiety, this system often runs in overdrive. When you anticipate a social situation, your hypothalamus releases corticotropin-releasing hormone, triggering a cascade that ultimately floods your bloodstream with cortisol. While this response evolved to protect us from genuine threats, in social anxiety it activates for perceived threats—like speaking up in a meeting or making small talk at a gathering.

Simultaneously, your GABAergic system—the brain’s primary “brake pedal” for anxiety—may be underperforming. GABA (gamma-aminobutyric acid) is the major inhibitory neurotransmitter that calms neuronal firing. Research indicates that individuals with anxiety disorders often show reduced GABA receptor binding in key brain regions, particularly the amygdala, which processes emotional salience and threat detection.

The serotonergic system adds another layer. Dysregulation of serotonin neurotransmission has long been implicated in social anxiety, which is why selective serotonin reuptake inhibitors (SSRIs) remain first-line pharmaceutical interventions. But what’s particularly relevant is how these neurotransmitter systems interact with the sympathetic nervous system—that fight-or-flight machinery that makes your heart race and palms sweat before social encounters.

This brings us to melatonin’s unexpected role in the anxiety equation.

Melatonin: Beyond Sleep, Into Anxiety Territory

Most people know melatonin as the “sleep hormone,” synthesized in the pineal gland when darkness falls. But groundbreaking research has revealed that melatonin’s influence extends far beyond regulating circadian rhythms. Its concentration in cerebrospinal fluid is significantly higher than in blood, suggesting important neuromodulatory functions.

Dr. Jacob Rosenberg and his research team at the University of Copenhagen’s Center for Perioperative Optimization have been at the forefront of investigating melatonin’s anxiolytic properties. Their comprehensive Cochrane review analyzing 27 randomized controlled trials involving 2,319 participants found that melatonin given as premedication probably reduces preoperative anxiety in adults, with effects potentially comparable to benzodiazepines.

But here’s where it gets interesting for those trying to stop avoiding people due to social anxiety: melatonin’s mechanisms of action target the same neurobiological systems implicated in social anxiety disorder.

How Melatonin Calms the Anxious Brain

Melatonin exerts anxiolytic effects through multiple interconnected pathways. First, it modulates the HPA axis that drives your stress response. Research demonstrates that melatonin can dampen the hyperactivity of this system, reducing excessive cortisol secretion that amplifies anxiety. This sympatholytic action—reducing sympathetic nervous system overactivity—translates to fewer of those physical anxiety symptoms that make social situations unbearable.

Second, melatonin interacts with the GABAergic system. While it doesn’t directly bind to GABA receptors like benzodiazepines, it appears to enhance GABAergic tone through indirect mechanisms. This helps restore the balance between excitation and inhibition in anxiety-processing brain regions.

Third, melatonin influences the serotonergic system through interactions with serotonin receptors, particularly the 5-HT2 receptors. The hormone’s antioxidant properties shouldn’t be overlooked either—oxidative stress and free radical production play underappreciated roles in anxiety pathophysiology.

Perhaps most intriguingly, research from BMC Neuroscience suggests melatonin facilitates fear extinction—the process by which we learn that feared situations are actually safe. In rat studies, melatonin given before extinction training significantly reduced freezing behavior during both extinction training and testing phases. This matters enormously because fear extinction forms the neurobiological foundation of exposure therapy, the gold-standard treatment for anxiety disorders.

The Behavioral Foundation: Exposure Therapy and Beyond

Understanding melatonin’s potential is valuable, but it cannot replace the proven behavioral interventions that form the cornerstone of social anxiety treatment. If you’re serious about learning how to stop avoiding people due to social anxiety, exposure therapy represents your most effective tool.

The premise is straightforward but challenging: repeatedly facing feared social situations without engaging in avoidance or safety behaviors allows your brain to learn that the anticipated catastrophe doesn’t materialize. This new learning doesn’t erase the old fear memory; rather, it competes with it in what neuroscientists call a “retrieval competition.” When the new, safer memory wins this competition, anxiety diminishes.

Effective exposure therapy for social anxiety typically follows a hierarchy. You might begin with less threatening situations—perhaps maintaining eye contact with a cashier—before progressing to more challenging scenarios like giving a presentation or attending a party where you know few people. The key is consistent practice without relying on safety behaviors (those subtle tactics like scrolling through your phone to appear busy or positioning yourself near exits).

Social Mishap Exposures: Embracing the Feared Outcome

Here’s where treatment approaches have evolved beyond traditional exposure. Research published in specialized clinical journals has demonstrated that “social mishap exposures” can accelerate progress. Unlike standard exposure practices that help you realize catastrophes are unlikely, social mishap exposures deliberately create the feared outcome. You intentionally do something embarrassing—perhaps purposely mispronouncing words during a presentation or wearing mismatched shoes to a gathering—to discover that these “social catastrophes” are actually survivable and far less devastating than your anxiety predicts.

This approach directly challenges what researchers call “estimated social cost”—your exaggerated belief about how terrible social mistakes will be. When you discover through direct experience that fumbling your words doesn’t result in lasting shame or social exile, the anxiety’s grip loosens.

Cognitive restructuring complements exposure work. This involves identifying and modifying the distorted thought patterns that fuel avoidance. Common cognitive distortions in social anxiety include mind reading (“Everyone thinks I’m boring”), catastrophizing (“If I blush, it will be horrible and everyone will think I’m incompetent”), and filtering (noticing the one person who looks disinterested while ignoring the five who appear engaged).

Bringing It Together: A Comprehensive Approach

So where does melatonin fit into this picture if you’re working to stop avoiding people due to social anxiety? The research suggests it may serve as a valuable adjunct to behavioral interventions, not a replacement for them.

Consider melatonin’s demonstrated ability to facilitate fear extinction. If you’re engaging in exposure therapy—the most effective behavioral treatment—melatonin’s neuroplasticity-enhancing properties could theoretically make those exposures more effective by supporting the neural rewiring necessary for new learning to stick. The hormone’s anxiolytic effects might also make it easier to initiate exposures in the first place, reducing the activation energy required to face feared situations.

The safety profile is another advantage. Clinical reviews note that melatonin causes minimal adverse effects, with most resolving spontaneously within days. Unlike benzodiazepines, melatonin doesn’t impair psychomotor or cognitive function—crucial factors when you need to be mentally sharp during social situations. There’s no evidence of dependency or withdrawal, concerns that plague conventional anxiolytics.

Research on patients undergoing breast cancer surgery by Dr. Melissa Hansen and colleagues found that 6 mg of melatonin taken daily significantly reduced the risk of depressive symptoms and anxiety over a three-month period. The MEDACIS trial investigating melatonin in post-cardiac patients is exploring similar benefits, examining whether prophylactic melatonin can prevent the development of anxiety symptoms in high-stress medical contexts.

When to Seek Professional Help

While understanding these mechanisms and interventions is empowering, it’s essential to recognize when professional guidance becomes necessary. If social anxiety significantly impairs your ability to work, maintain relationships, or engage in activities essential to your wellbeing, evaluation by a mental health professional is crucial.

Social anxiety disorder exists on a continuum. Occasional nervousness about social situations differs fundamentally from the persistent, impairing fear that characterizes the clinical disorder. Professional treatment might involve cognitive-behavioral therapy with a trained therapist who can guide exposure exercises, provide accountability, and adjust interventions based on your progress.

Some situations warrant consideration of prescription medications. SSRIs remain the first-line pharmaceutical treatment for social anxiety disorder, with robust evidence supporting their efficacy. For acute situations, benzodiazepines may be prescribed, though their dependency risk and cognitive effects make them problematic for long-term use.

Practical Steps Forward

If you’re determined to stop avoiding people due to social anxiety, here’s a reality-grounded approach:

Start with self-assessment. Track your avoidance patterns for one week. Which social situations do you consistently avoid? What thoughts precede the avoidance? What physical sensations do you experience?

Create an exposure hierarchy. List 10-15 social situations in order from least to most anxiety-provoking. Begin practicing with situations you rate as 3-4 out of 10 on your anxiety scale, not the most frightening ones.

Commit to consistency. Sporadic exposure won’t rewire your brain. The new learning that replaces fear requires regular practice to become stronger than the old fear memories.

Consider supportive supplementation. While not a standalone solution, melatonin’s safety profile and demonstrated anxiolytic properties make it worth discussing with a healthcare provider, particularly if you’re already experiencing sleep difficulties (common in anxiety disorders). For information on other supplements that support overall wellbeing, exploring evidence-based options can complement a comprehensive treatment approach.

Challenge cognitive distortions. When anxiety whispers “Everyone will judge you,” counter with evidence: “I’ve been to social gatherings before where I felt anxious, and looking back, no one actually seemed to notice or care about the things I worried about.”

Embrace imperfection. Social mishap exposures teach a profound lesson—mistakes don’t destroy us. In fact, vulnerability often strengthens rather than weakens social connections.

The path from avoidance to engagement isn’t linear. You’ll have setbacks. Some social situations will feel manageable; others will trigger intense anxiety despite your progress. That’s not failure—it’s part of the reconditioning process.

The Bigger Picture

Recent statistics reveal an unsettling trend: anxiety levels have climbed steadily from 32% of adults reporting increased anxiety in 2022 to 43% in 2024. Economic uncertainty, political polarization, climate concerns, and the lingering effects of the COVID-19 pandemic have collectively created an environment where anxiety feels not just personal but collective.

Yet this context makes understanding how to stop avoiding people due to social anxiety more crucial, not less. Social connection isn’t a luxury—it’s a fundamental human need with documented impacts on both physical and mental health. When anxiety blocks us from meaningful connection, we suffer not just psychologically but physiologically.

The research on melatonin’s anxiolytic properties represents one promising avenue in a larger landscape of interventions. It’s not a miracle cure, nor is any single intervention likely to be sufficient for moderate to severe social anxiety. But combined with evidence-based behavioral strategies, supported by professional guidance when needed, and backed by an understanding of the underlying neurobiology, meaningful change becomes possible.

Your anxiety didn’t develop overnight, and it won’t disappear that quickly either. But each small act of approaching rather than avoiding, each moment of tolerating discomfort rather than fleeing from it, each social interaction completed despite the fear—these accumulate into a new story about who you are and what you’re capable of.

The question isn’t whether you can eliminate social anxiety entirely (probably not, and some anxiety serves adaptive functions). The question is whether you can learn to face it, function despite it, and gradually reduce its authority over your life choices. Based on both the scientific evidence and countless recovery stories, that answer is yes.

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FAQ

Q: What is social anxiety disorder and how does it differ from general shyness?

A: Social anxiety disorder (SAD) is a clinical condition characterized by persistent, intense fear of social situations where judgment might occur, leading to significant impairment in daily functioning. Unlike shyness, which is a personality trait, SAD involves excessive anxiety that disrupts work, relationships, and quality of life, often accompanied by physical symptoms like rapid heartbeat, sweating, and trembling. People with SAD typically engage in extensive avoidance behaviors and experience anticipatory anxiety days or weeks before social events.

Q: How does the HPA axis relate to social anxiety?

A: The hypothalamic-pituitary-adrenal (HPA) axis is your body’s primary stress response system. It begins with the hypothalamus releasing corticotropin-releasing hormone, which triggers the pituitary to release ACTH, ultimately causing the adrenal glands to secrete cortisol. In social anxiety, this system often shows hyperactivity, meaning your body launches a full stress response to perceived social threats (like conversations or presentations) even when no genuine danger exists. This chronic HPA axis dysregulation contributes to both the psychological and physical symptoms of social anxiety.

Q: What does GABA do in the brain and why does it matter for anxiety?

A: GABA (gamma-aminobutyric acid) is the primary inhibitory neurotransmitter in the central nervous system. Think of it as your brain’s “brake pedal”—it reduces neuronal excitability and promotes relaxation by allowing chloride ions to flow into neurons, making them less likely to fire. Research shows that people with anxiety disorders often have reduced GABA receptor binding in key brain regions like the amygdala, essentially meaning their brakes don’t work as effectively, leading to heightened anxiety and difficulty calming down.

Q: How does melatonin reduce anxiety if it’s primarily a sleep hormone?

A: While melatonin is best known for regulating sleep-wake cycles, it also acts as a neurohormone with anxiolytic (anxiety-reducing) properties through multiple mechanisms: it modulates the HPA axis to reduce stress hormone production, enhances GABAergic signaling to calm neural activity, reduces sympathetic nervous system overactivity (the “fight or flight” response), and possesses antioxidant properties that protect against oxidative stress implicated in anxiety. Additionally, melatonin receptors (MT1, MT2, and MT3) are distributed throughout anxiety-processing brain regions, allowing melatonin to influence emotional regulation directly.

Q: What is fear extinction and why is it important for treating social anxiety?

A: Fear extinction is the neurological process by which your brain learns that a previously feared stimulus or situation is actually safe. It doesn’t erase the original fear memory; instead, it creates a new, competing memory. When you repeatedly face a feared social situation without the predicted catastrophe occurring, your brain forms new neural pathways that associate that situation with safety rather than danger. This process underlies exposure therapy’s effectiveness—melatonin’s demonstrated ability to facilitate fear extinction in research studies suggests it might enhance the neuroplasticity necessary for exposure therapy to successfully rewire anxiety responses.

Q: What are social mishap exposures in the treatment of social anxiety?

A: Social mishap exposures are a specialized form of exposure therapy where you deliberately create mildly embarrassing situations rather than just facing situations where embarrassment might accidentally happen. For example, you might intentionally mispronounce words, wear mismatched clothing, or purposely make a minor social faux pas. The goal is to directly test and disprove your exaggerated beliefs about how catastrophic social mistakes are—when you discover that these “mishaps” don’t result in the devastating consequences you feared, your estimated social cost (how terrible you believe social mistakes will be) decreases, reducing overall social anxiety.

Q: What are safety behaviors and why should they be avoided during exposure therapy?

A: Safety behaviors are subtle actions you take to prevent the feared outcome or reduce anxiety during a feared situation. Examples include avoiding eye contact, rehearsing what you’ll say, positioning yourself near exits, holding objects to keep hands from shaking, or using alcohol before social events. While they provide short-term relief, safety behaviors prevent you from learning that you can handle the situation without them, maintaining the cycle of anxiety. Effective exposure therapy requires facing situations without these crutches so your brain can learn that you’re safe even without them.

Q: What is cognitive restructuring in the context of treating social anxiety?

A: Cognitive restructuring is a therapeutic technique that involves identifying distorted thought patterns (cognitive distortions) that fuel anxiety and systematically challenging and replacing them with more accurate, balanced thoughts. Common distortions in social anxiety include mind reading (“Everyone thinks I’m boring”), catastrophizing (“If I stumble over my words, it will be terrible”), and filtering (focusing only on the one person who looks uninterested while ignoring others who appear engaged). Cognitive restructuring helps you evaluate evidence for and against anxious thoughts, developing more realistic assessments of social situations.

Q: Can melatonin replace benzodiazepines for anxiety treatment?

A: While research shows melatonin may have anxiolytic effects comparable to benzodiazepines for certain types of anxiety (particularly preoperative anxiety), it’s not a direct replacement for prescription medications in treating clinical anxiety disorders. Melatonin’s advantages include a favorable safety profile, no dependency risk, minimal cognitive impairment, and few side effects. However, benzodiazepines work through different mechanisms and may be necessary for severe anxiety or acute situations. Any consideration of replacing prescription medications should only occur under professional medical supervision—never discontinue prescribed anxiety medications without consulting your healthcare provider.

Q: What does “anxiolytic” mean?

A: Anxiolytic (pronounced an-zee-oh-LIT-ik) means “anxiety-reducing” or “anti-anxiety.” It’s used to describe substances, medications, or interventions that reduce anxiety symptoms. The term comes from “anxio-” (anxiety) and “-lytic” (to loosen or dissolve). Benzodiazepines, SSRIs, and certain behavioral therapies are all considered anxiolytic treatments, and emerging research suggests melatonin possesses anxiolytic properties as well.

Q: How long does it typically take to see improvement when working on social anxiety?

A: The timeline varies significantly based on anxiety severity, treatment approach, consistency of practice, and individual factors. With structured cognitive-behavioral therapy including exposure exercises, many people notice some improvement within 8-12 weeks, though substantial change often requires 3-6 months of consistent work. Some symptoms may improve quickly (like reducing overt avoidance), while others (like changing core beliefs about social situations) take longer. Recovery isn’t linear—you’ll experience ups and downs. The key is maintaining consistent practice even during setbacks, as the neural rewiring necessary for lasting change requires time and repetition.

Q: When should someone seek professional help for social anxiety?

A: Seek professional evaluation if social anxiety significantly impairs your daily functioning, including your ability to work, maintain relationships, attend necessary appointments, or engage in activities important to your wellbeing. Other indicators include: anxiety that feels overwhelming or unmanageable despite self-help efforts, symptoms that have persisted for six months or longer, developing additional mental health concerns like depression, using alcohol or substances to cope with social situations, or experiencing frequent panic attacks in social contexts. A mental health professional can provide accurate diagnosis, evidence-based treatment recommendations, and support tailored to your specific situation.

Q: What is the serotonergic system and how does it relate to social anxiety?

A: The serotonergic system refers to the network of neurons that use serotonin (5-hydroxytryptamine or 5-HT) as their neurotransmitter. Serotonin plays crucial roles in mood regulation, emotional processing, anxiety modulation, and social behavior. Research indicates that dysregulation of serotonin neurotransmission contributes to social anxiety disorder—this is why selective serotonin reuptake inhibitors (SSRIs) are first-line pharmaceutical treatments. Genetic variations in serotonin-related genes, particularly the serotonin transporter gene, have been linked to increased anxiety risk, especially when combined with stressful life experiences.

Q: Are there any side effects of taking melatonin for anxiety?

A: Melatonin is generally well-tolerated with a favorable safety profile. Potential side effects are typically mild and include headache, dizziness, nausea, and daytime drowsiness. Most side effects resolve spontaneously within a few days or immediately after discontinuation. Unlike benzodiazepines, melatonin doesn’t cause psychomotor or cognitive impairment, dependency, or withdrawal symptoms. However, melatonin can interact with certain medications (including blood thinners, immunosuppressants, and diabetes medications), so it’s important to consult a healthcare provider before starting supplementation, especially if you have existing health conditions or take other medications.

Q: What is the sympathetic nervous system and its role in social anxiety?

A: The sympathetic nervous system is part of the autonomic nervous system responsible for your “fight or flight” response. When activated, it increases heart rate, dilates pupils, redirects blood to muscles, and triggers the release of stress hormones—all preparing your body to face or flee from danger. In social anxiety, the sympathetic nervous system often activates inappropriately in response to perceived social threats (like conversations or being observed), causing the familiar physical symptoms: racing heart, sweating, trembling, and shortness of breath. Melatonin’s sympatholytic action (reducing sympathetic nervous system activity) helps explain its anxiolytic effects by dampening this overactive stress response.